What’s the hold-up? Time to tackle ‘delayed discharges’ in our hospitals
Every year, as winter approaches, our A&E departments come under increasing pressure. Winter, especially for the elderly and most vulnerable patients, can be a worrying time. Coughs and colds, flu viruses and conditions that are exacerbated by the wet or cold weather all add up to extra pressure as people who are unable to get an appointment with their busy GPs opt for a trip to A&E.
Despite a number of awareness campaigns asking people with common ailments to seek alternative methods of treatment, such as their local pharmacy, winter inevitably sees a rise in admission rates in our hospitals.
Despite these increasing numbers, many patients will of course be treated there and then. But it’s what happens when more complex treatment is required that the problems begin. 1 in 5 patients will now experience what the NHS calls a ‘delayed discharge’ where they are unable to return home as appropriate community care is not available. Many elderly patients may require home carers or nurses to be arranged, may need equipment installed, such as grab rails or stair lifts, or are waiting for a care home place. It is an issue that’s getting worse.
In England, the number of 'delayed discharges' has reached record levels. When all care environments – hospitals, mental health facilities and smaller community hospitals – are taken into account, 160,000 delayed discharges are being reported per month. For some patients the delay will be a few days, but for others it can be weeks. Two patients in Wales were found to have been on wards for over 6 months.
Inevitably, all these delays have a knock on effect to the rest of the NHS. Waits in A&E increase as beds are harder to find and ambulances are forced to wait for A&E staff to become available so they can hand over their patients. The system grinds to a halt.
So what’s the answer? Many are calling for increased investment in social care to try and free up valuable beds. Another approach adopted in Scotland has already proved effective. Delayed discharges in Scotland have fallen by 8% owing to investment in ‘intermediate care beds’ – where beds are set aside by care homes so that hospitals can discharge patients. They can then be re-assessed and appropriate care sourced. After 100 of these beds were opened up in Glasgow, the effects were dramatic. On the first Monday of December 2014 year 117 patients waited more than 72 hours. On the first Monday in December 2015 the number of patients waiting was just 27.
With winter upon us, it’s vital that steps are taken to free up the pressure on the system. The more pressure, the more mistakes we are likely to see and the more patients will be put at risk. With NHS senior management recently bringing together all performance data on a monthly basis, it is not possible to get an overview of how the entire system is doing and whether targets are being met. As has been widely reported in the press, it is not just discharge rates that are falling short:
- The last time ambulances hit their target to answer 75% of the most serious 999 calls in eight minutes was May 2015.
- One of the key cancer targets - the 62-day target for treatment to start - has not been hit for over a year.
- The NHS 111 phone service is missing its target to answer 95% of calls within 60 seconds.
This winter, one thing is clear – unless we can decide on an effective plan to tackle the increased flow in and out of our hospitals – we can expect more delays and more patients waiting for the essential care they need. If it’s putting our most vulnerable patients at risk, perhaps it’s time to follow the Scottish model and look to free up beds elsewhere?
By Jonathan Zimmern, Senior Associate
Jonathan is a barrister in our medical negligence and personal injury department, Jonathan has been dealing with complex and high value cases for over 7 years, acting for those injured through medical negligence or personal injury accidents.
Jonathan’s cases cover many areas, including:
Jonthan has dealt with a number of high profile cases including a claim for a 13 year old girl left quadriplegic after a routine spinal operation. The case was covered in the national press and by regional news broadcasters.